LONG TERM CARE

•Financing Long Term Care

•Financing Long Term Care

• THE NEED FOR LONG-TERM CARE SERVICES IN THIS COUNTRY IS EXPECTED TO INCREASE DRAMATICALLY.

• IN 2011, 77 MILLION PEOPLE WILL TURN 65.

• IN 2025, MEDICARE BENEFICIARIES IS EXPECTED TO REACH 69.3 MILLION REPRESENTING 20.6% OF THE POPULATION

• OVER THE SAME PERIOD, THOSE OVER AGE 80 WILL COMPRISE THE FASTEST GROWING SEGMENT OF THE POPULATION.

• FOUR OUT OF EVERY TEN PEOPLE TURNING 65 WILL USE A NURSING HOME AT SOME POINT AND MANY WILL NEED HOME CARE.

• EXPENDITURES FOR ELDERLY LIVING IN THE COMMUNITY WERE THREE TIMES THOSE OF THE NONELDERLY IN 1996.

• $5,655 VS. $1,865

• PROJECTED TO GROW TO $7,674 BY 2005.

• MEDICARE AND MEDICAID LONG-TERM EXPENDITURES ARE PROJECTED TO DOUBLE BY 2005.

• AN OBSERVATION

ONE PROJECTION OF LONG-TERM CARE COSTS FOR PEOPLE WHO WERE AGE 67 IN 1995 FOUND THAT THE AVERAGE MALE COULD EXPECT COSTS OF $56,895 WHILE THE AVERAGE FEMALE COULD EXPECT COSTS OF $124,370. BECAUSE NEITHER MEDICARE NOR PRIVATE HEALTH INSURANCE COVERS MOST OF THESE COSTS, AND BECAUSE FEW PEOPLE HAVE SUFFICIENT RETIREMENT INCOME OR SAVINGS TO MEET THEM ON THEIR OWN, MANY PEOPLE WHO REQUIRE LONG-TERM CARE ULTIMATELY BECOME DESTITUTE AND TURN TO MEDICAID.

• HOW IS LONG-TERM CARE CURRENTLY FINANCED?

MEDICAID IS THE LARGEST SINGLE PAYOR FOR NURSING CARE.

MEDICARE IS THE LARGEST SINGLE PAYOR FOR HOME AND COMMUNITY-BASED CARE.

TOGETHER, THEY PAY FOR 56% OF NURSING AND HOME CARE.

THE REST IS PAID BY FAMILIES.

TOTAL SPENT IN 1995…91 BILLION DOLLARS

•MEDICAID

MEDICAID IS THE FEDERAL-STATE PROGRAM OF MEDICAL ASSISTANCE FOR CERTAIN GROUPS OF THE POOR, INCLUDING FAMILIES WITH CHILDREN, THE ELDERLY, AND THE DISABLED.

ORDINARILY, PEOPLE QUALIFY FOR COVERAGE BY MEETING STRINGENT LIMITS ON INCOME AND ASSETS.

FOR THE ELDERLY AND DISABLED, THESE LIMITS ARE GENERALLY THOSE APPLICABLE UNDER THE FEDERAL SUPPLEMENTAL SECURITY INCOME (SSI) CASH ASSISTANCE PROGRAM - $494 PER MONTH IN 1998 – BUT LIMITS CAN BE HIGHER IN STATES THAT SUPPLEMENT SSI PAYMENTS.

MOST STATES ALLOW THE “MEDICALLY NEEDY” THOSE WHO LARGE MEDICAL BILLS REDUCE THEIR INCOME TO THE REQUIRED LEVEL TO PARTICIPATE.

MIDDLE INCOME NURSING RESIDENTS MAY QUALIFY THROUGH “SPEND DOWN” BECAUSE THE MONTHLY COST OF NURSING HOME CARE EXCEEDS THEIR PENSIONS OR OTHER RETIREMENT INCOME. RESIDENT MUST PAY FOR CARE OUT OF THEIR OWN ASSETS UNTIL THEY HAVE REACHED $2,000.

THE MEDICALLY NEEDY MUST CONTRIBUTE ALL OF THEIR INCOME TOWARD THE COST OF CARE EXCEPT FOR A SMALL PERSONAL NEEDS ALLOWANCE. ($30-$75 PER MONTH IN 1996.)

WHERE INCOME IS STILL GREATER THAN THESE MAXIMUMS, EXCESS INCOME IS PLACED INTO TRUST WHICH THE STATE MAY RECOVER AFTER DEATH OF THE INDIVIDUAL. (MILLER TRUST) PERSON MAY THEN RECEIVE MEDICAID.

MEDICAID LAW RESTRICTS ELGIBILITY FOR PERSONS WHO HAVE TRANSFERRED ASSETS WITHIN A FIXED TIME BEFORE ADMISSION AND IT PLACES LIMITS ON HOW MUCH INCOME CAN BE SHELTERED IN TRUSTS.

IN THE EVENT THAT A NURSING HOME RESIDENT HAS A SPOUSE REMAINING IN THE COMMUNITY, ALL STATES ARE REQUIRED TO PROTECT SPECIFIED AMOUNTS OF THE INCOME AND ASSETS OF THE INSTITUTIONALIZED SPOUSE FOR THE MAINTENANCE OF THE COMMUNITY SPOUSE.

IN 1996, PROTECTED INCOME AMOUNTS FOR THE COMMUNITY SPOUSE RANGED FROM $1,295 TO $1,919 PER MONTH, PROTECTED RESOURCES FROM $15,348 TO $76,740.

NOT ALL STATES PERMIT “SPEND DOWN.” SOME STATES HAVE INCREASED THE LEVEL TO THREE TIMES THE SSI INCOME LEVEL ($494) TO $1,482.

WHERE INCOME IS STILL GREATER THAN THESE MAXIMUMS, EXCESS INCOME IS PLACED INTO TRUST WHICH THE STATE MAY RECOVER AFTER DEATH OF THE INDIVIDUAL. (MILLER TRUST) PERSON MAY THEN RECEIVE MEDICAID.

MEDICAID LAW RESTRICTS ELGIBILITY FOR PERSONS WHO HAVE TRANSFERRED ASSETS WITHIN A FIXED TIME BEFORE ADMISSION AND IT PLACES LIMITS ON HOW MUCH INCOME CAN BE SHELTERED IN TRUSTS.

IN THE EVENT THAT A NURSING HOME RESIDENT HAS A SPOUSE REMAINING IN THE COMMUNITY, ALL STATES ARE REQUIRED TO PROTECT SPECIFIED AMOUNTS OF THE INCOME AND ASSETS OF THE INSTITUTIONALIZED SPOUSE FOR THE MAINTENANCE OF THE COMMUNITY SPOUSE.

IN 1996, PROTECTED INCOME AMOUNTS FOR THE COMMUNITY SPOUSE RANGED FROM $1,295 TO $1,919 PER MONTH, PROTECTED RESOURCES FROM $15,348 TO $76,740.

•MEDICARE

MEDICARE PROVIDES LIMITED BENEFITS FOR SHORT STAYS IN SKILLED NURING FACILITIES. THE BENEFIT IS LIMITED TO 100 DAYS OF COVERAGE PER EPISODE OF ILLNESS AND IS AVAILABLE ONLY FOLLOWING HOSPITALIZATION AND ONLY FOR PERSONS REQUIRING DAILY SKILLED NURSING OR REHABILITATION CARE.

•LONG-TERM CARE INSURANCE TODAY

DEFINITION: A PRIVATE LONG-TERM CARE INSURANCE (LTCI) POLICY PROVIDES PAYMENT TOWARD NECESSARY LONG-TERM CARE SERVICES.

IT MAY THEREFORE SEEM TO PARALLEL HEALTH INSURANCE, WHICH PAYS FOR ACUTE CARE, BUT LTCI IS REALLY MUCH MORE LIKE LIFE INSURANCE.

PREMIUMS FOR LTCI POLICIES ARE SET WITH THE ASSUMPTION THAT MOST BUYERS WILL PAY PREMIUMS FOR SOME YEARS BEFORE REQUIRING SERVICES.

FOR EXAMPLE, A 50-YEAR-OLD-WOMAN WHO BUYS LTCI MAY NOT NEED CARE UNTIL SHE IS 80 OR NEVER.

THE RATES ARE SET ON THE ASSUMPTION THAT SHE WILL GO ON PAYING PREMIUMS THROUGHOUT THE INTERVENING YEARS, THUS BUILDING UPA POT OF MONEY THAT WILL BE AVAILABLE AS THE NEED FOR LONG-TERM CARE BECOMES MORE LIKELY.

THUS, LIKE LIFE INSURANCE, LTCI RELIES ON LONG-RANGE ACCUMULATION AND INVESTMENT OF PREMIUMS TO MEET A DISTANT FUTURE COST.

• THE COST DEPENDS ON HOW EARLY IN YOUR LIFE YOU OBTAIN THE INSURANCE.

•FEATURES

• GENERALLY, THE PREMIUM FOR LTCI IS FIXED FOR THE LIFE OF THE POLICY. UNDER MOST STATE LAWS, THE INSURER CANNOT INCREASE THE PREMIUM FOR AN INDIVIDUAL BECAUSE HE OR SHE GROWS OLDER OR DEVELOPS HEATLH PROBLEMS AFTER BUYING THE COVERAGE.

THE COVERAGE PROVIDED UNDER MOST LTCI POLICIES IS INDEMNITY IN COVERAGE IN THE TRADITIONAL SENSE. THAT IS, THE POLICY MAKES FIXED DOLLAR PAYMENTS FOR EACH UNIT OF SERVICE OBTAINED, REGARDLESS OF THE ACTUAL COST OF THE SERVICE.

BECAUSE THE COST OF LONG-TERM CARE WILL RISE OVER TIME, MOST POLICIES OFFER INFLATION PROTECTION FOR AN ADDITIONAL CHARGE.

LTCI GENERALLY PAYS BENEFITS ONLY FOR A FIXED PERIOD – E.G., TWO YEARS OF NURSING HOME CARE, ETC.

MANY POLICIES PROVIDE A ‘NONFORFEITURE” OPTION, WHICH ALLOWS A POLICYHOLDER WHO STOPS MAKING PREMIUM PAYMENTS TO RECOVER SOME OF THE ACCRUED VALUE OF THE POLICY.

•INCENTIVES TO PURCHASE LTCI

THE HEALTH INSURANCE AND PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) MADE THE FEDERAL TAX TREATMENT OF LTCI MORE COMPARABLE TO THAT OF HEALTH INSURANCE.

LTCI BENEFITS, UP TO CERTAIN LIMITS, ARE NOT TAXABLE.

LTCI PREMIUMS PAID BY INDIVDUALS MAY NOW BE COUNTED TOWARD THE MEDICAL EXPENSE DEDUCTION.

LTCI PREMIUMS PAID BY AN EMPLOYER, OR LONG-TERM CARE BENEFITS FURNISHED DIRECTLY BY AN EMPLOYER, ARE DEDUCTIBLE FOR THE EMPLOYER AND ARE NOT TAXABLE INCOME FOR THE EMPLOYEE.

• THE QUALITY OF LIFE ISSUE

DIGNITY AND PRIVACY.

DIGNITY AND PRIVACY.

POSITIVE AND SOCIAL RELATIONSHIPS AND MEANINGFUL SOCIAL ACTIVITY.

INDIVIDUALIZATION AND PERSONALIZATION OF CARE AND SERVICES.

A SENSE OF SAFETY AND SECURITY.

A SENSE OF SAFETY AND SECURITY.

AUTONOMY AND ALTERNATIVE CHOICES

A SENSE OF SAFETY AND SECURITY.

AUTONOMY AND ALTERNATIVE CHOICES

SPIRITUAL WELL-BEING.

A SENSE OF SAFETY AND SECURITY.

AUTONOMY AND ALTERNATIVE CHOICES

SPIRITUAL WELL-BEING

EFFECTIVE HANDLING OF PAIN AND DISCOMFORT

• End of Lecture for 3rd Period November 1st, 2006

• Questions?